What is it? 

This is the only prescribed bio-identical/body-identical progesterone available in New Zealand

It contains micronised progesterone.

It is better than the bio-identical hormones from compounding pharmacies because it is fully regulated (see here for more information on bio-identical hormones)

Many women feel better taking Utrogestan than when they take synthetic progestogens. Because it is bio-identical, it has the same molecular structure as our natural progesterone, so it has a strong attraction to our progesterone receptors. This means it tends not to bind to non-progesterone receptors, so it is much less likely to cause what’s known as progesterone intolerance (see here for more information)

Utrogestan also has a mild sedating action which helps improve your sleep.

Even more importantly, it has been shown to have less risks of breast cancer, heart disease and clots than synthetic progestogens.

 

How is oral Utrogestan taken?

Because of its mild sedating effect, it is taken in the evening before bed.

It is also best taken on an empty stomach; which means at least 1 hour before or 2 hours after food. 

 

What is the dose for oral Utrogestan?

There are different regimes around, but the simplest ones to start with are usually the following:

 

CYCLICAL REGIME

For women still having periods:

Take 2 capsules (200mg) at night for 2 weeks out of every 4 weeks

 

CONTINUOUS REGIME

For women who’ve had no period for 6-12 months or had a hysterectomy for severe endometriosis:

1 capsule (100mg) every night.

 

 

What if a woman still experiences progesterone intolerance on oral Utrogestan?

It is possible to use the same capsules vaginally - you simply pop them with a pin and then insert them as high as you can inside your vagina at bedtime. They are placed high-up because we are trying to get as near to the womb as possible because that’s where we want it to act.

Taking Utrogestan this way is much less likely to cause symptoms of progesterone intolerance.

There is some debate among the experts about what the vaginal dose should be.

Some argue that you only need half the oral dose (ie insert one capsule every other night for continuous HRT regimes, or insert one capsule at night for 2 weeks out of every 4 weeks, if on a cyclical regime)

But others, including the British Menopause Society, argue that the vaginal dose should be the same as the oral dose to ensure we are protecting the womb sufficiently.

So the jury is out on vaginal dosing - but there’s no doubt that some women feel much less ‘intolerant’ when they use this route.

 

Are there any downsides to choosing Utrogestan?

For most women, this is the progesterone of choice for their HRT due to its better side effect profile and least adverse effects/risks.

There are times however, when women may prefer one of the other synthetic options:

 

1. THEY NEED CONTRACEPTION

Utrogestan is not a form of contraception. So for women in perimenopause, they may prefer to use a Mirena as the progesterone part of their HRT.

 

2. THEY HAVE HEAVY PERIODS

If a woman is suffering with heavy periods, Utrogestan is not as good as the other synthetic progestogens at controlling this. She may therefore prefer to take oral Provera or Norethisterone, or have a Mirena.

 

3. THEY ARE STABLE ON THEIR CURRENT PROGESTOGEN

Some women have ticked along nicely for years on their synthetic progestogens and simply do not want to rock the boat and switch to something else.

 

REFERENCES:

Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric 2018;21:111-122.

Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA 1995;273:199-208. Erratum in: JAMA 1995;274:1676.

British Menopause Society Tools for Clinicians: Progestogens and Endometrial Protection